Tag Archives: Optimization

Physician Mobility?

Distracted practice

In my day to day, I am Queen Multitasker. I look like the guy in the photo trying to balance phone calls, note taking, and all the multimedia gadgets required of someone in my administrative position. Unfortunately, I know a fair number of colleagues look like this guy instead of the fitted one button coat, they are in their lab jackets in a hospital or office near you.

So what should happen to reduce the juggling of the gadgets? Can we balance accessibility and still practice efficiently? Can we foster 2-way patient interactions and still respect provider downtime? Yes, Yes, and Yes.

I believe it’s a combination of having multiple platforms integrated and optimized for the use of a busy and efficient provider. So what’s out there? We are an iOS world for now(Apple Rules, Android Users just get over it) If most consumers are like me, Steve Jobs’ company has gotten lots of my money over the years. There is the Apple watch, an Apple phone, as well as a tablet either surface or iPad Pro(The gold Ipad Pro is pretty but the verdict is still out on its usage in-house) but do any of these devices make the physician more efficient? Which front end dictation tool should be utilized and optimized? Nuance ™  apps it particularly Dragon Anywhere™ which I’ve been experimenting with more in the previous several weeks is particularly useful input tool.  I found in comparison to previous forms of Dragon™, Siri on my iPhone actually worked better than the previous iterations of the front end dictation tool really previously released by the company Nuance™. But there has been a marked improvement with the release of the Dragon Anywhere tool™. For a nominal subscription fee you have a hardware light version of Dragon™ on your phone. It has a more robust command structure as well as powerful editing tools in which you can enjoy the accuracy in the hardware heavy version of this tool.  I find that my ability to transfer and copy text into a Word document and then easily save it to my cloud Dropbox is almost seamless and then I can actually update the text and repeat that within less than 30 seconds. It has made my ability to post my blog a lot easier. I  still have to go back to my laptop/tablet to make the final corrections and formatting just because I find it easier but it actually has been a godsend as far as my ability to be able to create this post. (FYI, I’m using Dragon Anywhere™ to create this post.) I would suggest that you number 1, have the latest updates on your phone, have a subscription to office 360, and you can ensure that the embedded mic within your phone actually works well. The microphone on the iPhone has excellent noise canceling capabilities however what I have found is my Bluetooth, the accuracy has been affected by the LG 750 even up to LG 760 with a Bluetooth device.  You may actually have a better chance with a wired Beats™ as well as the white earbuds that actually come with your iPhone. I would also ensure that your screen saver or power saver mode is set to a minimum of 15 minutes or so before the  screen locks.

I am a iOS geek through and through.  However, the Surface 3 with Windows 10 and Citrix 14.3 from a healthcare information systems perspective actually affords the end-user the best experience and will truly increase their efficiency. And is also necessary to have a tool either like Dragon 360™ medical or Dragon Direct™. When Windows 10 was released someone told me you will experience a loss of functionality, but could not tell me exactly why. If the device is correctly imaged, with properly formatted applications, and Office 2016, it will only enhance your experience not detract from it. I just wish people that don’t have the full story and can’t give you clear directions on how to change something,  they need to take Madea’s advice and go and sit down somewhere and be quiet. We providers are under pressure from a regulatory standpoint to document thoroughly to tell the full story and to allow proper charges to be created and submitted in a timely manner. And from a business stand point, we are tasked to see as many patients as possible but still provide quality healthcare.  We should have the properly configured tools to allow us to maximize our time interacting with our patients and fellow staff members,  not inputting data into the EMR. Futuristic Complex

 

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CPOE Remix

One writes to seal knowledge in their brain.  Me, April 2016

Screen Shot 2016-04-12 at 11.26.06 AM
(Image from Making Computerized Provider Order Entry Work. 2013)

Working on my latest implementation I kept hearing about a methodology for #CPOE implementation. What was the most frustrating to me is I couldn’t find it anywhere. A successful methodology should be written down, clear, and easily obtain so the next time you have a major implementation of an electronic medical record, you don’t have to reinvent the wheel. If you’ve done this greater than 40 times it should be sealed in the brains of everyone. The only problem with that is in the intervening years many of the people have moved on to different roles, many more people have retired or they moved on to different organizations. So that the people that made up the principal team for implementation may not even be available anymore. Those that are left they remember only bits and pieces of their role and sometimes what they remember is not applicable in your current state.

Now with the new implementation the roles of all the players need to be clear prior to any kickoff meetings. If you plan on going to a new electronic medical record and if you plan on completing this in a 9 month time period, rapid implementation, your methodology really needs to be on point. Readiness Assessment, Governance Structures, Policy Implementation and Review, Key Roles Definition and accountabilities all need to be in place even more so then the change management as well as the project management. As a medical director, I had a role, but it  was not made clear to me until it was almost too late.  If you want to take on a greater role you have to be careful that you know what the roles ar of key players in an implementation so as not to overstep. You can’t rely on the inconsistent verbal statements and archived emails from six or eight years prior that I recieved. (So-Not-Cool.) I did not get a clear project plan, education plan, or implementation methodology until after the go live.  The age of the large scale go live ir practically over, except the DOD EHR Modernization project  and the Greenfield Implementations in the Middle East,  this is the decade of realignment and optimization. So what methodologies are out there for general consumption and what should be modified? I will be exploring over the next few posts what I can actually find this active in the blogosphere as well as in the electronic instruction manuals. I will detail how clinical process improvement is as necessary to sucessful practice as passing the boards. I also plan on detailing how some slight changes and automating certain aspects of a providers workflow in its current state will improve efficiency and add to work life balance.